1710950639 NPI number — DR. PAMELA BRUG MD

Table of content: DR. PAMELA BRUG MD (NPI 1710950639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710950639 NPI number — DR. PAMELA BRUG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUG
Provider First Name:
PAMELA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710950639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RARITAN BAY MEDICAL CENTER - DEPT. OB&GYN
Provider Second Line Business Mailing Address:
530 NEW BRUNSWICK AVE
Provider Business Mailing Address City Name:
PERTH AMBOY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-324-6065
Provider Business Mailing Address Fax Number:
732-324-6063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RARITAN BAY MEDICAL CENTER - DEPT. OB&GYN
Provider Second Line Business Practice Location Address:
530 NEW BRUNSWICK AVE
Provider Business Practice Location Address City Name:
PERTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-324-6065
Provider Business Practice Location Address Fax Number:
732-324-6063
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MA058810 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44459 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5838457 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2841357000 . This is a "AMERIHEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 91002215200 . This is a "AMERICHOICE#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6517404 . This is a "MEDICAID HEALTHSTART #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 14945 . This is a "UNIVERSITY HEALTH PLANS#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K5318 . This is a "HEALTHNET#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1149978 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60023562 . This is a "HORIZON NJ HEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3657176 . This is a "OXFORD#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8224340 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 83N201 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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